South Florida Hospital News
Friday February 26, 2021

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February 2021 - Volume 17 - Issue 8

Dr. Prieto Discusses Advancements in Pediatric Cardiology

According to Dr. Lourdes Prieto, "The beauty of what happens in the world of congenital cardiology is that as our patients grow into adulthood – and that is happening more and more because we are getting better at what we do – we, the pediatric cardiologists, can follow them, because we understand the cardiac problems they have even as they age."

That can be for a long period of time, because as Dr. Prieto – interventional pediatric and adult congenital cardiologist, and interim medical director of cardiology at Nicklaus Children's Hospital – explained, some of those problems can start moments after birth. She gave an example of what she called "transposition of the great arteries": The baby's heart develops in a way that the major arteries – the aorta, which flows out to the body, and the pulmonary artery, which goes to the lungs – are reversed. The result is that blood without oxygen is pumped to the body instead of to the lungs; whereas oxygenated blood coming back from the lungs is pumped back into the lungs instead of to the body. "When those babies are born their oxygen level can be very low, and a procedure may need to be done immediately, sometimes within an hour of birth."
Dr. Prieto discussed another problem that can occur in premature or very tiny babies, where they're born with what is called a patent ductus arteriosus (PDA). The PDA is a vessel that connects the aorta to the pulmonary artery, and in full-term babies it usually closes within hours of birth. However, in premature babies it can stay open and result in breathing problems. "We are now able to close that vessel with a catheterization procedure by putting a little plug in the PDA. That procedure we can now do in babies as tiny as 1-1/2 pounds."
She also talked about her surgical colleagues being interested in augmented reality, and "bringing it to the operating room." A special lens is used to generate a hologram from individual patients' hearts, allowing the surgeon to interact with the three-dimensional anatomy of a specific heart. By doing so, surgeons are able to determine how best to repair a cardiac lesion that requires surgical intervention. "Eventually they're hoping to bring this into the operating room so they can look at it at the same time they're looking at the actual heart. Bringing augmented reality into the OR would enable the surgeon to see exactly what the heart looks like before getting inside."
Another advancement Dr. Prieto mentioned deals with lesions that previously required surgical intervention, but can now be treated with catheterization procedures. "I'm a cardiac cath specialist, and now in our field, we can implant valves in the heart in the catheterization laboratory. More and more, things that used to require open heart surgery can now be done via a less invasive procedure by putting a catheter from the groin vessels into the heart, including replacing a valve. There's no scar, and patients go home the next day feeling essentially back to baseline, sometimes better! Many still require surgery, but the field of transcatheter interventions has grown exponentially in the past couple of decades."
Dr. Prieto has been serving as interim medical director of cardiology since there was a change in leadership of the cardiology division at the hospital several weeks ago. Until the position is permanently filled – which she may be considered for – she intends to carry out her priorities. Among them are continuing to expand services into the community. "We have opened clinics as far as Palm City, so we have physicians who are seeing patients in Broward and Palm Beach Counties. We have been able to extend our services to areas that are currently not able to access us easily, and I'm hoping to continue that in my role."
Another area she is hoping to expand is fetal echo consultation. "When moms are pregnant and they have an ultrasound, generally the obstetrician can tell if there is a cardiac abnormality. You can imagine what a shock that is to a mom. We offer comprehensive counseling for patients in that situation. My hope is to increase our services to moms who may be carrying a baby with congenital heart disease, providing consultations to their homes, letting them know what to expect when the baby is born. It is safer for a baby with significant congenital heart disease to have a plan of action already in place when they're born. We'll know exactly what we need to do; and knowing in advance is safer and leads to better outcomes."

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